OBJECTIVES: High-resolution ultrasonography (US) can play an important role in studying nerves, as it has several advantages. Entrapments of distal tibial nerve branches can be mapped out or diagnosed with selective anesthetic blocks, and US can guide therapeutic procedures, such as radiofrequency ablation and selective infiltrations of specific nerve branches. The aim of this study was to verify that US is an effective method for accurately locating the posterior tibial nerve and its terminal branches, such as the medial calcaneal branch, the first calcaneal branch, and the medial and lateral plantar nerves...

The tibial nerve is the larger terminal branch of the sciatic nerve and it terminates in the tarsal tunnel by giving lateral and medial plantar nerves. We present a rare case of trifurcation of the tibial nerve within the tarsal tunnel. The variant nerve curves laterally after branching from the tibial nerve and courses deep to quadratus plantae muscle. Interestingly, posterior tibial artery was also terminating by giving three branches. These branches were accompanying the terminal branches of the tibial nerve...

Retinacula are thickenings of deep fascia in the region of joints that hold down the tendons preventing them from bowing out of position. In the region of ankle, number of such retinacula have been described. Retinacula like superior and inferior extensor retinacula have been described which hold down the tendons of leg muscles passing to the foot beneath them. As the extensor tendons of the leg have more distal attachment to the toes, the present study was conducted to ascertain the presence of any additional retinaculum in the mid-foot region, which would tie down the tendons for their effective action at the distal joints...

Tarsal tunnel syndrome (TTS) is one of the frequently encountered entrapment neuropathies of the lower limb. Most often the aetiology is considered to be idiopathic. However, it has to be thoroughly investigated to rule out diverse extrinsic and intrinsic causes. The sustentaculum tali (ST) forms the superior part of the distal tarsal tunnel, and any increase in its size may result in irritation of the tibial nerve or its branches, the medial and lateral plantar nerves or decrease the overall volume of the tarsal tunnel culminating to clinical features of TTS...

BACKGROUND: Calcaneal osteotomies are commonly used to correct varus hindfoot alignment in patients with symptomatic cavovarus deformity. Translational, closing wedge, and Malerba-type osteotomies have been implicated in the development of tarsal tunnel syndrome and neurologic injury to branches of the tibial nerve. The authors hypothesized that there would be minimal clinically important injury to the tibial nerve by performing a translational calcaneal osteotomy from a medial approach...

INTRODUCTION: Synovial chondromatosis is a rare, benign monoarticular condition characterized by the metaplastic formation of cartilaginous nodules from the synovium of joints (intra-articular), tendons and bursae (extra-articular). These nodules have the potential to detach and form loose bodies within the joint space. The most common locations are the large joints such as the knees, hips, elbows, and shoulders, with less common locations being the foot and ankle joints. Synovial chondromatosis primarily occurs in men between the third and fifth decades of life, and it typically presents as chronic joint pain with swelling, decreased joint range of motion, and osteoarthritis...

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its terminal branches within its fibro-osseous tunnel beneath the flexor retinaculum on the medial side of the ankle. The condition is frequently underdiagnosed leading to controversies regarding its epidemiology and to an intense debate in the literature. With the advent of nerve imaging techniques, the diagnostic confirmation and the etiological identification have become more accurate. However, management of this entrapment neuropathy remains challenging because of many intervention strategies but limited robust evidence...

Glomus tumors are painful benign neoplasms. They commonly present in the hand and are mostly solitary lesions. We report a rare case of multiple glomus tumors in the lower leg. Moreover, 1 of the tumors was in the tarsal tunnel. Resection of the tumors resulted in the early diagnosis of glomus tumors and complete symptom relief. Because of its rarity, diagnosing an extradigital glomus tumor is difficult. Recognition of glomus tumors allows for an early diagnosis and resection, and preoperative magnetic resonance imaging helps in the detection of multiple lesions...

BACKGROUND: Hallux valgus is the lateral deviation of the great toe at the MTPJ that has many attributing aetiologies. This study will aim to identify whether hallux valgus progresses over time in the oriental Chinese population in Hong Kong. METHODS: Patients with acquired symptomatic hallux valgus who presented to clinic between 2008 and 2013 were included. The deformities were analysed radiologically at presentation and pre-operative and angles were measured...

Painful tarsal tunnel syndrome is a compression neuropathy with a variety of possible sources. As it presents a challenging differential diagnostic problem, it is often under-diagnosed. Among the intrinsic and extrinsic factors, varicose veins are the main source in case of a venous etiology. We report a case of a 39-year old male patient who presented with complaints of paresthesia and excessive pain of the right foot, especially the medial side. Further work up by ultrasonography, magnetic resonance imaging and electromyography revealed an extensive congenital venous malformation of the right lower limb with subsequent compression of the tibial nerve in the tarsal tunnel...

The fine dissection of nerves and blood vessels in the tarsal tunnel is necessary for clinical operations to provide anatomical information. A total of 60 feet from 30 cadavers were dissected. Two imaginary reference lines that passed through the tip of the medial malleolus were applied. A detailed description of the branch pattern and the corresponding position of the posterior tibial nerve, posterior tibial artery, medial calcaneal nerve and medial calcaneal artery was provided, and the measured data were analyzed...

The tarsal tunnel ganglion is a cause of posterior tarsal tunnel syndrome. Open resection of the ganglion calls for release of the flexor retinaculum and dissection around the tibial neurovascular bundle. This can induce fibrosis around the tibial nerve. We report the technique of endoscopic resection of the tarsal tunnel ganglion. It is indicated for tarsal tunnel ganglia arising from the adjacent joints or tendon sheaths and compressing the tibial nerve from its deep side. It is contraindicated if there is other pathology of the tarsal tunnel that demands open surgery; if the ganglion compresses the tibial nerve from its superficial side, which calls for a different endoscopic approach using the ganglion portal; or if an intraneural ganglion of the tibial nerve is present...

A 52-year-old male complained of numbness and radiating pain affecting the plantar region of his left foot. He was found to have recurrent tarsal tunnel syndrome due to posterior tibial nerve compression by 3 different types of ganglion during a 12-year period. To the best of our knowledge, a similar case has not been documented. At the first operation, flexor retinaculum release and simple excision of an epineural ganglion were performed without injuring the nerve fascicles; however, an intrafascicular ganglion developed approximately 2 years later...

PURPOSES: To review the outcome of Z-plasty of the flexor hallucis longus (FHL) tendon at the tarsal tunnel for checkrein deformity in 8 patients. METHODS: Records of 6 males and 2 females aged 14 to 67 (mean, 39.5) years who underwent Z-plasty (lengthening) of the FHL tendon at the tarsal tunnel for checkrein deformity in the first and second toes by a single surgeon were reviewed. All patients had undergone 3 months of conservative treatment. The mean time from injury to surgical treatment was 8...

OBJECTIVE: In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less-invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain. PATIENTS AND METHODS: Between April 2013 and March 2015, we treated 17 consecutive elders with LBP, buttock pain, and leg pain. They were 4 men and 13 women ranging in age from 85 to 91 years (mean 86...

We present the first known case of cyst fluid localized to an articular branch without involvement of the larger parent nerve. During a routine tarsal tunnel decompression in a patient with fluctuating plantar foot symptoms and "normal" magnetic resonance imaging findings, we identified cyst fluid within an articular branch of the lateral plantar nerve to the subtalar joint. Our incidental intraoperative discovery was corroborated by retrospective review of the magnetic resonance images. Although we do not know whether this cyst was responsible for the patient's complaints, we believe this finding represents a snapshot into the life cycle of intraneural ganglion cysts: either the "birth" of an ultra-early one or the remnant of a once larger one...

Abnormalities of the medial ligaments and posterior tibial tendon can occur because of acute injury or chronic instability or malalignment. Medial ankle injuries may occur because of pronation or supination-external rotation injuries. Deltoid ligament injuries have a significant impact on lateral ankle instability but can be overlooked in patients with lateral ligament injuries. Posterior tibial tendon dysfunction is usually associated with spring ligament or flexor retinaculum injury. Tarsal tunnel syndrome, accessory flexor muscles, and subtalar coalition should be considered as well as ligament and tendon tears in differential diagnosis of chronic medial ankle pain...

Accessory muscles around the ankle are commonly encountered as incidental findings on cross-sectional imaging. Mostly asymptomatic, accessory muscles sometimes mimic mass lesions. They have been implicated as the cause of tarsal tunnel syndrome, impingement of surrounding structures, and chronic pain. Distinguishing these muscles can be challenging, because some travel along a similar path. This article describes these accessory muscles in detail, including their relationships to the aponeurosis of the lower leg...